What can you not take with zopiclone? Alcohol, painkillers and other medicines

What can you not take with zopiclone? You should not drink alcohol with it, and you should only take it with opioid painkillers such as codeine if your prescriber has decided the combination is needed. Other sleeping pills, anxiety medicines, some antidepressants, sedating antihistamines, some antibiotics and antifungals, some epilepsy and HIV medicines, St John’s wort and grapefruit can also affect zopiclone. Always check with your pharmacist before taking anything new.

This guide explains which medicines, drinks and remedies interact with zopiclone, why, and what to do about it. It draws on the UK product information, the NHS and the medicines regulator (MHRA). For a full overview of the medicine, see our complete guide to zopiclone.

The two ways other medicines can interact with zopiclone

Type of interaction	What happens	Examples from UK product information
Adding together (sedation)	Two medicines that slow the brain and nervous system add to each other. You may feel much sleepier, and breathing can slow.	Alcohol, opioid painkillers, other sleeping pills, anxiety medicines, antidepressants, antipsychotics, epilepsy medicines, sedating antihistamines
Changing zopiclone levels	Some medicines slow down or speed up how your liver clears zopiclone. Levels in your blood can rise or fall.	Raise levels: erythromycin, clarithromycin, itraconazole, some HIV medicines, grapefruit. Lower levels: rifampicin, carbamazepine, phenytoin, phenobarbital, St John’s wort

The UK Summary of Product Characteristics (SmPC) for zopiclone lists both types in its interactions section. The liver enzyme involved is called CYP3A4.

Zopiclone and alcohol: do not mix them

The NHS zopiclone page is clear: do not drink alcohol while taking zopiclone. It explains that alcohol can increase the effects of the medicine, which can cause breathing problems and make it very difficult to wake up.

The UK patient information leaflet (PIL) adds that the effect may last until the next morning. That can affect your ability to drive or use machines. The SmPC also says alcohol raises the risk of sleepwalking and other complex sleep behaviours.

If you have already had a drink, do not take zopiclone that night until you have asked a pharmacist or NHS 111 for advice.

Zopiclone and painkillers, including codeine

Codeine and other opioids

Opioids include codeine, co-codamol, tramadol, morphine and oxycodone. The PIL notes that some cough medicines contain opioids too. The zopiclone SmPC warns that using sedatives like zopiclone with opioids increases the risk of sedation, breathing problems (respiratory depression), coma and death.

Because of this, UK product information says the two should only be prescribed together when other treatment options are not possible. If your prescriber does decide this, they should use the lowest dose for the shortest time. The PIL suggests telling friends or relatives the warning signs, such as unusual sleepiness and difficulty breathing.

The MHRA warned in March 2020 that benzodiazepines, or benzodiazepine-like drugs, and opioids can both cause breathing problems that can be fatal. It advises patients to tell prescribers about any opioids or sedative medicines they take.

Never add an over-the-counter codeine product to zopiclone without checking with a pharmacist first. If you take an opioid for pain, see our guide to tapentadol side effects, which explains opioid breathing risks in more detail.

Paracetamol and ibuprofen

Paracetamol is not listed as an interaction in the zopiclone SmPC or on the NHS zopiclone page. Zopiclone is also not on the NHS list of medicines that may not mix with paracetamol. Ibuprofen is not listed in the zopiclone interactions section either.

That does not make every combination product safe. Co-codamol, for example, contains codeine as well as paracetamol. Check the full ingredients and ask your pharmacist which painkiller suits you.

Gabapentin and pregabalin

These are epilepsy medicines that are also used for nerve pain. The zopiclone SmPC lists antiepileptics among the medicines that can add to its sedating effect. The NHS pregabalin page says to tell your doctor if you take medicines that make you feel sleepy or dizzy.

The MHRA has also warned that gabapentin can rarely cause severe breathing problems. It lists taking other medicines that depress the central nervous system as one of the risk factors.

Other sleeping pills and anxiety medicines, such as diazepam

The NHS lists other medicines for sleep or anxiety problems among those that may not mix well with zopiclone. Diazepam is a benzodiazepine used for anxiety and some other conditions. The NHS diazepam page says it can make you feel sleepy.

The zopiclone SmPC says combining it with other hypnotics, anxiety medicines or sedatives should be carefully considered. This is because the effect on your brain and breathing may be increased.

So do not take diazepam and zopiclone together unless the same prescriber knows about both and has told you how to use them. Never take a leftover tablet, or one from someone else, to help you sleep. As our guide on whether zopiclone is addictive explains, both types of medicine carry a risk of dependence.

Antidepressants: mirtazapine, amitriptyline and sertraline

If you take an antidepressant, the UK PIL asks you to tell your doctor or pharmacist if you take any antidepressant, because it may affect how zopiclone works.

Antidepressant	What the NHS says	What it means with zopiclone
Mirtazapine	Usually taken at bedtime because it can make you sleepy. The NHS mirtazapine page lists benzodiazepines among medicines that may not mix well.	Both can make you drowsy, so the effects may add up. Ask your prescriber whether you need both.
Amitriptyline	The NHS warns that taking it with opioids can make you very drowsy and cause breathing problems.	Extra drowsiness is possible. The risk is higher if you also take an opioid.
Sertraline	The NHS sertraline page lists dizziness or drowsiness as possible side effects. It does not name sleeping pills as an interaction.	Tell your prescriber you take both. Do not drive if you feel drowsy.

Do not stop an antidepressant to make room for zopiclone. Speak to your prescriber or pharmacist instead.

Medicines that raise or lower zopiclone levels

Zopiclone is broken down in the liver by the CYP3A4 enzyme. The SmPC gives these examples.

Medicines that can raise zopiclone levels

• Macrolide antibiotics, such as erythromycin and clarithromycin. In a study in healthy people, erythromycin raised zopiclone exposure by 80%.
• Azole antifungals, such as itraconazole. Itraconazole raised the amount of zopiclone reaching the bloodstream by about 70%.
• HIV protease inhibitors.
• Grapefruit and grapefruit juice. The PIL says to avoid them because grapefruit can increase the effect of zopiclone.

Higher levels can mean stronger sleepiness and more next-morning effects. The SmPC says a lower zopiclone dose may be needed. Only your prescriber can decide that.

Medicines that can lower zopiclone levels

• Rifampicin, an antibiotic used for tuberculosis. The SmPC says it lowers zopiclone levels by about 80%.
• Some epilepsy medicines: carbamazepine, phenytoin and phenobarbital.
• St John’s wort, a herbal remedy.

If zopiclone seems to stop working after you start one of these, do not take extra. Tell your prescriber. Our zopiclone dose guide explains why you should never change your dose yourself.

Hay fever, allergy and over-the-counter remedies

The NHS lists medicines for hay fever, rashes or other allergies that can make you feel sleepy, such as chlorphenamine and promethazine, among those that may not mix well with zopiclone. Some of these are available without seeing a doctor.

Before you take any medicine from a shop or pharmacy, read the label and tell the pharmacist you take zopiclone. The same goes for herbal remedies, vitamins and supplements. The NHS asks you to mention all of these before starting zopiclone.

The SmPC also lists illegal substances among things that increase next-day impairment. If you use any recreational drugs, tell your doctor honestly so they can advise you safely.

Interactions, driving and the law

The NHS says not to drive, ride a bike or use machinery for 12 hours after taking zopiclone. Alcohol, other sedatives and medicines that raise zopiclone levels can make next-day effects stronger or longer.

Under the UK drug-driving law, it is illegal in England, Scotland and Wales to drive with legal drugs in your body if they impair your driving. Many medicines often taken alongside zopiclone, such as codeine, tramadol, morphine and diazepam, are on the GOV.UK list of drugs to talk to your doctor about before driving. Our guide to zopiclone side effects covers next-day effects in more detail.

Legal status and sharing medicines

Zopiclone became a Class C drug under the Misuse of Drugs Act 1971 in 2014. It was added to Schedule 4 Part 1 of the Misuse of Drugs Regulations from 10 June 2014. You may only have it if it is prescribed for you.

Never give your zopiclone to anyone else, even if they take similar medicines. Your prescriber has checked your other medicines. They have not checked theirs. Read more in our guide to controlled drugs in the UK.

This article is for information only and does not replace advice from your doctor or pharmacist. Read our medical disclaimer.